The Public Health Ramifications of Supreme Court’s Rulings

The Supreme Court’s recent trio of landmark rulings—relaxing concealed carry gun laws, overturning Roe V. Wade, and limiting the power of the Environmental Protection Agency (EPA) to regulate power-plant emissions industry wide—have generated all manner of political and judicial blowback. Those who stand to benefit from the rulings applaud the court’s historic actions, and critics condemn them as extreme judicial overreach.

But more important than politics is the very real impact the rulings are likely to have—in both the short and long term—on the health of Americans, whose lives are decidedly affected by any decisions involving pollution, guns, and abortion.

These are some of the possible public-health consequences of these decisions. What can we expect in the coming years, as they make their way into the actual body politic?

More polluted air—and inflammation—for all

Of the recent rulings, West Virginia v. Environmental Protection Agency has the most nationwide impact, if only because all of us share and breathe air, and all of us are thus touched by the smokestack emissions produced by the country’s 3,477 fossil-fueled power plants. The ruling struck down the EPA’s power to cap emissions across that entire sector, concluding that such authority went beyond the regulatory scope of what the 1970 Clean Air Act allowed. Medical experts believe this is bad news.

An increase in carbon emissions could lead to an even greater problem with global warming. The sixth hottest year, and the 45th straight year that global temperatures have risen above 20th-century averages was last year’s. This is according to data from the National Oceanic and Atmospheric Administration. According to a study by the National Center for Biotechnology Information, each year about 12,000 Americans are killed from extreme heat.

Continue reading: How to Cool Down When It’s Really Hot Outside

That figure is likely a gross underestimate, because extreme heat exacerbates all manner of underlying conditions like cardiovascular disease, dementia, COPD, and more—meaning that it’s those conditions, not the temperature, that gets listed as the official cause of death, cautions Dr. Aaron Bernstein, a pediatrician at Boston Children’s Hospital, and the interim director of the Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health. “It’s hard to disentangle,” Bernstein says. “People don’t have heat listed as the number-one diagnosis on their death certificate.”

It’s not just the temperature, of course, that causes smokestack emissions to be harmful. So do the key pollutants the power plants emit, especially sulfur dioxide, nitrogen oxides, carbon dioxide, mercury, and particulate matter—the last of which causes especially great concern.

According to the EPA coarse particulate matters are linked with childhood asthma. The condition is reported by the U.S. Centers for Disease Control and Prevention as affecting more than 4.2 Million American kids aged 18 and below.

Particulate matter in all its forms is associated with asthma. “Particulate matter is a pro-inflammatory exposure,” says Bernstein. “When these particles get into our bodies, they will light them up, causing damage to everything—the brain, the blood, the heart, the lungs.” Such inflammation, Bernstein says, may exacerbate depression and anxiety and may even be linked to suicide—a connection supported by a meta-analysis published in 2019 in the journal Environmental Health Perspectives. Alzheimer’s disease is also likely exacerbated by air pollution, says Dr. Ceclia Sorensen, professor of emergency medicine and environmental health sciences at Columbia University.

Not all Americans suffer from polluted air to the same degree, and—as so often happens— people of color and lower-income communities get hit the hardest, as the chart below shows. The United States has a large number of fossil fuel-fired power stations that are situated in low-income communities. These include communities where most residents have not completed high school or who do not speak English.

“Air pollution is not an equal opportunity killer,” says Bernstein.

Sorensen believes this type of disparity is a vicious cycle. “People who are already economically disadvantaged are getting bigger medical bills and more health problems, which further cripple their ability to get out of poverty,” she says. “There are huge environmental justice issues across the country—pockets of it in every city, every state, every urban economy.”

Public exposure is more dangerous than ever.

Public risk can be posed in a completely different way by New York State Rifle & Pistol Association v. Bruen, the Supreme Court’s controversial gun-control ruling. The case involved a New York State law that required gun owners within the state’s borders to have a license to carry a concealed gun outside the home and to show “good cause” to obtain that license. They had to prove that they were required to have a concealed gun license to use outside their home. This was in addition to being armed for self defense. Although the court disregarded the good cause provision, it made it much easier for them to get a license. Six other states—California, Hawaii, Maryland, Massachusetts, New Jersey, and Rhode Island—have similar laws on the books, and theirs are now mooted, too.

That’s troubling news in a country reeling from more than 300 mass shootings so far in 2022—even with a modest but real gun safety bill recently passed by Congress and signed into law by President Joe Biden. Experts fear that more shootings are inevitable if more people own guns.

“Disagreements outside a bar might turn into gunfire,” says Nick Suplina, senior vice president for law and policy at Everytown for Gun Safety. “It might mean a scary situation in the subway resulting in a person drawing and firing their concealed weapon. You can carry your concealed weapon in states where you are not allowed to. [lead to gunfire] because tempers flare.”

These concerns go beyond speculation. According to a National Bureau for Economic Research paper, states that have weaker laws regarding handguns saw their homicide rate increase 11% while violent crime rose by as much as 15% in the 10 years following the adoption of those laws. The same research group also published a 2022 paper that examined gun laws in 47 cities. It found that concealed-carry laws were linked to a 29% rise in violent firearm crimes. “Increased public carry leads to worse public safety outcomes,” Suplina says.

In his dissent in the Bruen decision, Justice Stephen Breyer cited the 45,222 Americans killed by guns in 2020—a number that Jon Lowy, vice president and chief counsel at the anti-gun-violence group Brady, calls “a public health crisis.” Public-health experts agree on that classification. “As leaders in medicine, our unique perspective on firearm violence as a grave public health crisis is informed by scientific research and the clinical experiences of physicians,” said Dr. Jack Resneck, Jr., president of the American Medical Association, in a statement. “In emergency departments across the country, physicians are first-hand witnesses to the catastrophic fallout of firearm violence while caring for victims with devastating, life-threatening injuries that are preventable.”

“Society should address the problem comprehensively,” Lowy says, “which includes strengthening laws regulating guns, more effectively requiring safety features, requiring sales to be more reasonable, and careful public education. These are the sorts of things we do with tobacco and motor vehicle deaths and opioids.”

While guns, cars, heroin, and tobacco don’t have Constitutional amendments backing them up like opioids and cigarettes, they do. In light of that, Brady is helping states—especially the ones that have New York-type laws—draft new legislation that can restrict concealed carry as much as possible, consistent with the Bruen decision. The Supreme Court did not forbid carve-outs to the new ruling: for example, allowing prohibitions of concealed carry in “sensitive places” like schools, government buildings, and polling places. Immediately after the decision had been handed down, New York passed a law enumerating 14 such sensitive places, including any place that serves alcohol, any place children gather, entertainment venues, houses of worship, health care and medical facilities, and Manhattan’s Times Square.

Other states could see similar laws. The public-health crisis in the United States isn’t going away soon, despite having more gun owners than citizens.

Less body autonomy—with riskier outcomes

The most tectonic of the Supreme Court’s recent trio was Dobbs v. Jackson Women’s Health OrganizationThe nearly 50 year-old decision was overturned Roe V. Waderuling made abortion an inherent Constitutional right. Even ignoring the incendiary political implications of the decision, women in post-Roe will have real health consequences.

The U.S. is already a dangerous place to be pregnant, with a maternal mortality rate of 24 deaths per 100,000 live births—much higher than the rate in comparable advanced nations, as the chart below shows. This alarming rate includes 55 deaths per 100,000 live-births for Black women. Banning or severely restricting abortions means that more high-risk pregnancies that would have been terminated will instead be brought to term, with potentially disastrous results for the mother, as TIME’s Jamie Ducharme has reported.

A 2021 study showed that abortion bans in the United States would cause pregnancy-related death rates to increase by 20% for all women and 33% for Black women. The maternal mortality rate in 2017. This is well before the Dobbs ruling. It was 28.5 deaths for every 100,000 live births in those states that have strict limits on the gestational age or pre-procedural wait periods. By contrast, it was 15.7 deaths in states which allow abortion through the first three months. According to an article published in the journal. Contraception.

Others could also contribute. States which restrict abortion access before-Dobbs are often those that did not expand Medicaid under the Affordable Care Act and have fewer practicing medical professionals—raising the dangers associated with pregnancy overall. This is where a large number of African-Americans live in poverty.

This does not mean that maternal health will suddenly be valued in post-Roe society. The always difficult work involved in pregnancy will be made more hazardous.

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